ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

1. The earliest recognizable erythroid precursor on a Wright-stained smear of the bone

marrow is:
A. pronormoblast
B. basophilic normoblast
C. CFU-E
D. BFU-E
2. An increase in the reticulocyte count should be accompanied by:
A. a shift to the left in the Hb-O2 dissociation curve
B. abnormal maturation of normoblasts in the bone marrow
C. an increase in total and direct serum bilirubin
D. polychromasia on the Wright's-stained blood smear

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

3. Which of the following is not a characteristic of reticulocytes?

A. Reticulocytes, like mature erythrocytes, cannot use oxygen to produce energy.
B. Reticulocytes account for about 1% of all red cells in the blood of a normal adult.
C. Reticulocytes, unlike mature erythrocytes, can still synthesize haemoglobin.
D. Reticulocytes normally contain more membrane cholesterol than do mature erythrocytes.
4. The primary effector (cause) of increased erythrocyte production, or erythropoiesis, is:
A. supply of iron
B. rate of bilirubin production
C. tissue hypoxia
D. rate of EPO secretion

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

5. The erythrocyte life span is most directly determined by:

A. spleen size
B. serum haptoglobin level
C. membrane deformability
D. cell size and shape
6. What property of the
throughnormal erythrocyte
3-mcM fenestrations in the spleen?
membrane allows the
A. fluidity
7-mcM cell to squeeze
B. elasticity
C. permeability
D. deformability

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

7. To use glucose to produce ATP, mature erythrocytes:

A. have to take in glucose from plasma at the expense of ATP
B. consume 2 ATP molecules, but also produce 4 ATP molecules per glucose molecule
C. consume O2 carried by hemoglobin molecules within themselves
D. produce CO2 and release this waste product in the lung during respiration
8. Extravascular erythrocyte destruction occurs in:
A. the bloodstream
B. macrophages in the spleen
C. the lymph nodes
D. bone marrow sinuses

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

9. A normal erythrocyte:
A. has a normal life span of about 60 days
B. contains about 30 pg of haemoglobin
C. has a diameter of about 4 mcM so it can squeeze through capillaries of similar diameter
D. contains about 5 femtomoles of Na+ and 9 femtomoles of K+
10. An increase in 2,3-BPG occurs at high altitude in an effort to:
A. increase oxygen affinity of hemoglobin
B. decrease oxygen affinity of hemoglobin
C. decrease the concentration of methemoglobin
D. protect the cell from oxidant damage

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

11. A patient lost about 1500 mL of blood during surgery but was not given blood
transfusions. His hemoglobin before surgery was in the reference range. The most likely finding
3 days later would be:
A. increase in total bilirubin
B. increase in indirect bilirubin
C. increase in erythropoietin
D. increased haptoglobin
12. Results of a CBC revealed a MCHC of 40 g/dL. What characteristic of the RBC will this
affect?
A. oxygen affinity
B. cell metabolism
C. membrane permeability
D. cell deformability

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

13.A 50-year-old patient had a splenectomy after a car accident that damaged her spleen. She had
a CBC performed at her 6-week postsurgical checkup. Many target cells were identified on the
blood smear. This finding is most likely:
A. an indication of liver disease
B. a loss of RBC membrane peripheral proteins
C. an abnormal protein to phospholipid ratio of the RBC membrane
D. an accumulation of cholesterol and phospholipid in the RBC membrane
14. If the erythrocyte cation pump fails because of inadequate generation of ATP, the result is:
A. decreased osmotic fragility due to formation of target cell
B. formation of echinocytes due to influx of potassium
C. cell crenation due to efflux of water and sodium
D. cell swelling due to influx of water and cations

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

15.As a person ascends to high altitudes, the increased activity of the Rapoport-Luebering
pathway:
A. causes precipitation of hemoglobin as Heinz bodies
B. has no effect on oxygen delivery to tissues
C. causes increased release of oxygen to tissues
D. causes decreased release of oxygen to tissues
16. In mature erythrocytes:
A. NADPH is used to reduce methohemoglobin back to haemoglobin
B. The price of producing a 2,3-BPG molecule is to gen-erate two less ATP molecules
C. NADH is used to regenerate reduced guthathione (GSH)
D. Glucose is metabolized to form CO2

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

17.A laboratory professional finds evidence of Heinz bodies in the erythrocytes of a 30-year- old
male. This is evidence of:
A. increased oxidant concentration in the cell
B. decreased hemoglobin-oxygen affinity
C. decreased production of ATP
D. decreased stability of the cell membrane
18. Which of the following is not a feature of senescent erythrocytes?
A. Anion exchange protein 1 clusters on red cell membrane
B. IgG accumulates on red cell membrane
C. ATP production is maintained as usual
D. Phosphatidylserine is exposed on the outer leaflet of the red cell membrane

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

19.A patient with kidney disease has a hemoglobin of 8 g/dL. This is most likely associated
with:
A. decreased EPO production
B. increased intravascular hemolysis
C. abnormal RBC membrane permeability
D. RBC fragility due to accumulation of intracellular calcium
20. A 65-year-old female presents with an anemia of 3 weeks’ duration. In addition to a
decrease in her hemoglobin and hematocrit, she has a reticulocyte count of 6% and 3+
polychromasia on her blood smear. Based on these preliminary findings, what serum
erythropoietin result is expected?
A. decreased
B. normal
C. increased
D. no
correlatio
n

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

21. Which of the following is the correct molecular structure of hemoglobin?

A. four heme groups, two iron, two globin chains
B. two heme groups, two iron, four globin chains
C. two heme groups, four iron, four globin chains
D. four heme groups, four iron, four globin chains
22. During exercise, the oxygen affinity of hemoglobin is:
A. increased in males but not females
B. decreased due to production of heat and lactic acid
C. unaffected in those who are physically fit
D. affected only if the duration is more than 1 hour

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

23. 2,3-BPG combines with which type of hemoglobin?

A. oxyhemoglobin
B. relaxed structure of hemoglobin
C. deoxyhemoglobin
D. ab dimer
24. Which of the following types of hemoglobin is the major component of adult hemoglobin?
A. HbA
B. HbF
C. HbA2
D. Hb Portland

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

25. One of the most important buffer systems of the body is the:
A. chloride shift
B. Bohr effect
C. heme–heme interaction
D. ODC
26. Which of the following is considered a normal haemoglo-bin concentration in an adult
male?
A. 11.0 g/dL
B. 21.0 g/dL
C. 15.0 g/dL
D. 9.0 g/dL

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

27. When iron is depleted from the developing erythrocyte, the:

A. synthesis of heme is increased
B. activity of ALAS is decreased
C. formation of globin chains stops
D. heme synthesis is not affected
28. Which of the following is true for glycated hemoglobin?
A. Glycated hemoglobin is an abnormal minor hemoglobin in adults.
B. Glycated hemoglobin is produced via enzymatic glycation of the alpha globin chains.
C. HbA1c level reflects the average level of blood glucose over the previous 2–3 months.
D. HbA and HbA1c have the same net electric charge.

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

29.A patient with an anemia due to increased extravascular hemolysis would likely present with
which of the following lab results?
A. increased haptoglobin
B. hemoglobinuria
C. normal hemoglobin and hematocrit
D. increased serum bilirubin
30. Which of the following features is not unique to intravascular hemolysis?
A. depletion of plasma haploglobin
B. Methemalbuminemia
C. Hemoglobinuria
D. Hemosiderinuria

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

31. Which of the following hemoglobins is not found in the normal adult?
A. a2b2
B. a2g2
C. a2d2
D. a2e2
32. When iron in the cell is replete, the translation of ferritin mRNA is:
A. increased
B. decreased
C. unaffected
D. variable

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

33.A college student from Louisiana vacationed in Colorado for spring break. He arrived at
Keystone Resort on the first day. The second day, he was nauseated and had a head-ache. He
went to the medical clinic at the resort and was told he had altitude sickness. The doctor told him
to rest for another 24 hours before participating in any activities. What is the most likely reason
he will overcome this condition in the next 24 hours?
A. His level of HbF will increase to help release more oxy-gen to the tissues.
B. The amount of carboxyhemoglobin will decrease to normal levels.
C. The levels of ATP in his blood will reach maximal levels.
D. The level of 2,3-BPG will increase and, in turn, decrease oxygen affinity.
34. In the lungs, a hemoglobin molecule takes up two oxygen molecules. What effect will this
have on the haemoglobin molecule?
A. It will increase oxygen affinity.
B. It will narrow the heme pockets blocking entry of additional oxygen.
C. The hemoglobin molecule will take on the tense structure.
D. The center cavity will expand, and 2,3-BPG will enter.

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

35.A 25-year-old male was found unconscious in a car with the motor running. Blood was
drawn and sent to the chemistry lab for spectral analysis. The blood was cherry red in color.
Which hemoglobin should be tested for?
A. sulfhemoglobin
B. methemoglobin
C. carboxyhemoglobin
D. oxyhemoglobin
36. A 2-year-old patient who had been cyanotic since birth was seen by a pediatrician. Blood
was drawn for analysis of NADH methemoglobin reductase and results were normal. What
follow- up test would you suggest to the physician?
A. hemoglobin electrophoresis
B. bone marrow aspiration and examination
C. haptoglobin and sulfhemoglobin determination
D. glycosylated hemoglobin measurement by
column chromatography

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

37.The oxygen dissociation curve in a case of chronic carboxy-hemoglobin poisoning would

show:
A. a shift to the right
B. a shift to the left
C. a normal curve
D. decreased oxygen affinity
38. Nitric oxide (NO):
A. is produced inside the erythrocytes from arginine via the action of NO synthase
B. is a vasoconstrictive agent
C.reacts with artificial haemoglobin-based oxygen carriers in solution to cause complications like
vasoconstriction
D. is removed once it reacts with oxyhemoglobin

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

39.An anemic patient has hemosiderinuria, increased serum bilirubin, and decreased
haptoglobin. This is an indication that there is:
A. increased intravascular hemolysis
B. decreased extravascular hemolysis
C. hemolysis accompanied by renal disease
D. a defect in the Rapoport-Leubering pathway
40. Which of the following is true for the hemoglobin break-down products?
A. Heme iron cannot be reused by the body.
B. Carbon monoxideis one of the hemoglobin break-down products.
C.Unconjugated bilirubin is freely transported in the plasma without binding to any other
molecule.
D. Most urobilinogen is excreted in the urine.

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

41. A compensatory mechanism to allow adequate oxygen delivery to the tissues at high
altitudes, where oxygen concentrations are low, is which one of the following?
A. An increase in 2,3-BPG synthesis by the red cell
B. A decrease in 2,3-BPG synthesis by the red cell
C. An increase in hemoglobin synthesis by the red cell
D. A decrease in hemoglobin synthesis by the red cell
E. Decreasing the blood pH
42. A 2-year-old boy of normal weight and height is brought to a clinic because of excessive
fatigue. Blood work indicates anemia, with microcytic hypochromic red cells. The boy lives in a
100-year-old apartment building and has been seen ingesting paint chips. His parents indicate that
the child eats a healthy diet and takes a Flintstones vitamin supplement every day. His anemia is
most likely attributable to a deficiency in which one of the following?
A. Iron
B. Vitamin B12
C. Folate
D. Heme
E. Vitamin B6

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

43.Drugs are being developed that will induce the transcription of certain globin genes, which are
normally silent in patients affected with sickle cell disease. A good target gene for such therapy
in this disease would be which one of the following?
A. The α1-gene
B. The α2-gene
C. The γ-gene
D. The β-gene
E. The ζ-gene
44. A mature blood cell that lacks a nucleus is which one of the following?
A. Lymphocyte
B. Basophil
C. Eosinophil
D. Platelet
E. Neutrophil

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 ASSESSMENT EXAM- PART I (IMMUNOHEMATOLOGY LECTURE)

45.A family has two children, one with a mild case of thalassemia, and a second with a severe
case of thalassemia that requires frequent blood transfusions as part of the treatment plan. One
parent is of Mediterranean descent; the other is of Asian descent. Neither parent exhibits clinical
signs of thalassemia. Both children express 20% of the expected level of β-globin; the more
severely affected child expresses normal levels of α-globin, whereas the less severely affected
child expresses only 50% of the normal levels of α-globin. Why is the child who has a deficiency
in α-globin expression less severely affected?
A.Thalassemia is caused by a mutation in the α-gene, and the more severely affected child
expresses more of it.
B. The less severely affected child must be synthesizing the ζ-gene to make up for the
deficiency in α-chain synthesis.
C. The more severely affected child also has HPFH.
D. The more severely affected child produces more inactive globin tetramers than the less
severely affected child.
E. Thalassemia is caused by an iron deficiency, and when the child is synthesizing normal
levels of α-globin, there is insufficient iron to populate all of the heme molecules synthesized.
46. An individual displays an anemic condition and upon molecular analysis is shown to be a
compound heterozygote for HbS/HbC. The symptoms exhibited by the patient are more severe
than those exhibited by patients with sickle cell trait (HbA/HbS) owing primarily to which one of
the following?
A. Increased concentration of HbC molecules in the patient’s RBCs
B. Increased volume of the patient’s RBCs
C. Increased concentration of HbS in the patient’s RBCs
D. Alterations in the patient’s RBC morphology
E. Precipitation of HbS molecules within the patient’s RBCs

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47.A young boy has been observed to have bluish fingertips and toes. Blood work indicates a
mild anemia, and molecular analysis indicates the child has an inherited erythrocyte pyruvate
kinase deficiency. This enzyme mutation leads to an increase in the 2,3-BPG levels in the
erythrocyte, which helps to ameliorate the effects of the mutation. The increase in 2,3-BPG levels
occurs because of which one of the following?
A.The lack of pyruvate kinase leads to an increase in 1,3-BPG levels, which is used to form 2,3-
BPG by the Rapoport-Luebering shunt pathway.
B.The increase in phosphoenolpyruvate levels leads to the phosphorylation of 3-
phosphoglycerate, forming 2,3-BPG.
C.The increase in phosphoenolpyruvate levels leads to the phosphorylation of 2-
phosphoglycerate, forming 2,3-BPG.
D.The increase in phosphoenolpyruvate levels leads to an increase in 3-phosphoglycerate,
which is phosphorylated by ATP to produce 2,3-BPG.
E.The lack of pyruvate kinase activity leads to an increase of glyceraldehyde 3-phosphate,
which is oxidized by an isozyme of glyceraldehyde 3-phosphate dehydrogenase to form 2,3-BPG.
48. A young boy was recently diagnosed with anemia, and further analysis demonstrated that
he had hereditary spherocytosis. This disease leads to anemia through which one of the following
mechanisms?
A. Lack of NADPH to protect cell membrane lipids and proteins from oxidation
B. Nutritional deficiency of iron, folate, or vitamin B12
C. Inability to reduce ferric hemoglobin to the normal ferrous state
D. Improper formation of the RBC membrane cytoskeleton
E. A mutation in heme synthesis

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49.A patient is a strict vegetarian and, as such, is concerned about getting sufficient iron in his
diet. Which suggestion below could increase his dietary iron absorption?
A. Never peel potatoes when preparing a potato dish.
B. Squeeze fresh lemon juice on spinach salad.
C. Reassure him that iron in plants is readily absorbed.
D. Meat is the only dietary source of iron.
E. Taking a vitamin with vitamin B12 would help iron absorption.
50. The pluripotent stem cell of the bone marrow produces all blood cells through different
lineages via induction of different differentiation pathways. Which one of the following is
produced from the same cell line as RBCs?
A. NK-cells
B. B-lymphocytes
C. T-lymphocytes
D. Basophils
E. Platelets

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